Physiotherapy - Original Articles
Early Access
Home-based and telehealth cardio-respiratory physiotherapy in northern Italy: a cross-sectional survey
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 22 December 2025
289
Views
143
Downloads
Authors
Cardiorespiratory physiotherapy (CRP) is an evidence-based process for individuals with both acute and chronic cardiorespiratory health conditions, yet access to center-based CRP in Italy is limited. Home-based and telehealth alternatives remain scarcely explored. This study investigated the status of CRP in the Lombardy region through a cross-sectional online survey distributed to physiotherapists registered with the Interprovincial Professional Register of eight provinces. A total of 388 responses were analyzed: 32 (8.2%) reported performing home-based CRP, and 9 (2.3%) reported telerehabilitation. Peripheral oxygen saturation was the most frequently assessed parameter (86%). Positive expiratory pressure devices were used for airway clearance (75%), and exercise reconditioning was consistently performed (79%). Variation was noted in lung re-expansion techniques, with some outdated methods still in use. Specific training in the use of telehealth facilities was often limited, and technological resources were essential for delivering telerehabilitation. The findings indicate that CRP beyond the clinic is still underutilized in Lombardy. Strengthening training programs and implementing standardized protocols could enhance access to and the quality of care. However, results are preliminary and limited by low representativeness and potential selection bias; therefore, they should not be considered generalizable.
Downloads
Download data is not yet available.
Citations
HERMES. ERS. Available from: https://www.ersnet.org/education-and-professional-development/medical-education-research/#Paediatricrespiratorymedicine-2.
Loddenkemper R, Séverin T, Eiselé JL, Haslam PL. HERMES: good reasons for harmonising education and training in respiratory medicine. Eur Respir J 2006;28:470-1. DOI: https://doi.org/10.1183/09031936.06.00084306
Kostikas K, Gaga M, Loukides S, et al. Harmonizing education in respiratory medicine in Europe. The Greek experience of the HERMES project. Pneumon 2012;25:373-6.
Troosters T, Tabin N, Langer D, et al. Introduction of the harmonised respiratory physiotherapy curriculum. Breathe 2019;15:110-5. DOI: https://doi.org/10.1183/20734735.0124-2019
Zampogna E, Oliva FM, Del Furia MJ, et al. Effectiveness of rehabilitation interventions in adults with asthma: a systematic review and meta-analysis. Am J Phys Med Rehabil 2025;104:e28-36. DOI: https://doi.org/10.1097/PHM.0000000000002552
Arienti C, Lazzarini SG, Andrenelli E, et al. Rehabilitation and COVID-19: systematic review by Cochrane Rehabilitation. Eur J Phys Rehabil Med 2023;59:800-18. DOI: https://doi.org/10.23736/S1973-9087.23.08331-4
Cordani C, Lazzarini SG, Zampogna E, et al. Dyspnea: a map of Cochrane evidence relevant to rehabilitation for people with post COVID-19 condition. Eur J Phys Rehabil Med 2022;58:864-9. DOI: https://doi.org/10.23736/S1973-9087.22.07805-4
Lamberton CE, Mosher CL. Review of the evidence for pulmonary rehabilitation in COPD: clinical benefits and cost-effectiveness. Respir Care 2024;69:686-96. DOI: https://doi.org/10.4187/respcare.11541
Troosters T, Janssens W, Demeyer H, Rabinovich RA. Pulmonary rehabilitation and physical interventions. Eur Respir Rev 2023;32:220222. DOI: https://doi.org/10.1183/16000617.0222-2022
Katayıfçı N, Boşnak Güçlü M, Şen F. A comparison of the effects of inspiratory muscle strength and endurance training on exercise capacity, respiratory muscle strength and endurance, and quality of life in pacemaker patients with heart failure: a randomized study. Heart Lung 2022;55:49-58. DOI: https://doi.org/10.1016/j.hrtlng.2022.04.006
Rochester CL. Barriers to pulmonary rehabilitation. Respir Care 2024;69:713-23. DOI: https://doi.org/10.4187/respcare.11656
Houchen-Wolloff L, Spitzer KA, Candy S. Access to services around the world. In: Holland AE, Dal Corso S, Spruit MA, eds. Pulmonary rehabilitation (ERS monograph). Sheffield: European Respiratory Society; 2021. pp. 258-72.
Spruit MA, Pitta F, Garvey C, et al. Differences in content and organisational aspects of pulmonary rehabilitation programmes. Eur Respir J 2014;43:1326-37. DOI: https://doi.org/10.1183/09031936.00145613
Desveaux L, Janaudis-Ferreira T, et al. An international comparison of pulmonary rehabilitation: a systematic review. COPD 2015;12:144-53. DOI: https://doi.org/10.3109/15412555.2014.922066
Ghaben SJ, Mat Ludin AF, Elkholi B, et al. Health inequity: Possibilities of initiating pulmonary telerehabilitation programs for adults with chronic obstructive pulmonary disorders in conflict and low-resourced areas; a mixed-method phenomenological study. PLoS One 2025;20:e0324624. DOI: https://doi.org/10.1371/journal.pone.0324624
Spruit MA, Wouters EFM. Organizational aspects of pulmonary rehabilitation in chronic respiratory diseases. Respirology 2019;24:838-43. DOI: https://doi.org/10.1111/resp.13512
Prvu Bettger J, Resnik LJ. Telerehabilitation in the age of COVID-19: an opportunity for learning health system research. Phys Ther 2020;100:1913-6. DOI: https://doi.org/10.1093/ptj/pzaa151
Cox NS, Dal Corso S, Hansen H, et al. Telerehabilitation for chronic respiratory disease. Cochrane Database Syst Rev 2021;1:CD013040. DOI: https://doi.org/10.1002/14651858.CD013040.pub2
Ora J, Prendi E, Attinà ML, et al. Efficacy of respiratory tele-rehabilitation in COPD patients: Systematic review and meta-analysis. Monaldi Arch Chest Dis 2022;92:2105. DOI: https://doi.org/10.4081/monaldi.2022.2105
Brouwers RWM, Scherrenberg M, Kemps HMC, et al. Cardiac telerehabilitation: current status and future perspectives. Neth Heart J 2024;32:31-7. DOI: https://doi.org/10.1007/s12471-023-01833-9
Briguglio M, Cordani C, Langella F, et al. Why treat patients with a major orthopaedic surgery only to send them back to the vulnerable conditions that made them sick in the first place? A conceptual scenario to improve patient's journey. Int J Gen Med 2023;16:4729-35. DOI: https://doi.org/10.2147/IJGM.S431055
Uzzaman MN, Agarwal D, Chan SC, et al. Effectiveness of home-based pulmonary rehabilitation: systematic review and meta-analysis. Eur Respir Rev 2022;31:220076. DOI: https://doi.org/10.1183/16000617.0076-2022
Liu S, Zhao Q, Li W, et al. The cost-effectiveness of pulmonary rehabilitation for COPD in different settings: a systematic review. Appl Health Econ Health Policy 2021;19:313-24. DOI: https://doi.org/10.1007/s40258-020-00613-5
Montero-Cámara J, Ferrer-Sargues FJ, Peredo DC, et al. Home-based physiotherapy programme reduces hospital stay and costs in cardiac surgery. A retrospective cohort study. Physiother Res Int 2025;30:e70032. DOI: https://doi.org/10.1002/pri.70032
McDonagh ST, Dalal H, Moore S, et al. Home-based versus centre-based cardiac rehabilitation. Cochrane Database Syst Rev 2023;10:CD007130. DOI: https://doi.org/10.1002/14651858.CD007130.pub5
Stephenson S, Wiles R. Advantages and disadvantages of the home setting for therapy: views of patients and therapists. Br J Occup Ther 2000;63:59-64. DOI: https://doi.org/10.1177/030802260006300203
Stark AL, Krayter S, Dockweiler C. Competencies required by patients and health professionals regarding telerehabilitation: a scoping review. Digit Health 2023;9:20552076231218841. DOI: https://doi.org/10.1177/20552076231218841
Federazione Nazionale degli Ordini della professione sanitaria di Fisioterapista. Comunicato Stampa – FNOFI, lancia la campagna per la Giornata Mondiale della Fisioterapia sul mal di schiena: consapevolezza e prevenzione per “Un Movimento che non si ferma”. Available from: https://www.fnofi.it/wp-content/uploads/2024/09/2024-09-05-Comunicato-FNOFI-Giornata-Fisioterapia.pdf. Accessed on: 19/10/2025. [Material in Italian].
Cieza A, Causey K, Kamenov K, et al. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2021;396:2006-17. Erratum in: Lancet 2021;397:198. DOI: https://doi.org/10.1016/S0140-6736(20)32340-0
Bennett C, Khangura S, Brehaut JC, et al. Reporting guidelines for survey research: an analysis of published guidance and reporting practices. PLoS Med 2010;8:e1001069. DOI: https://doi.org/10.1371/journal.pmed.1001069
Eysenbach G. Improving the quality of web surveys: the checklist for reporting results of internet e-surveys (CHERRIES). J Med Internet Res 2004;6:e34. DOI: https://doi.org/10.2196/jmir.6.3.e34
von Elm E, Altman DG, Egger M, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008;61:344-9. DOI: https://doi.org/10.1016/j.jclinepi.2007.11.008
Capecci M, Gandolfi M, Straudi S, et al. Shaping the future: an Italian survey unveils the unmet need to empower physical medicine and rehabilitation professionals with technological skills. Eur J Phys Rehabil Med 2024;60:540-3. DOI: https://doi.org/10.23736/S1973-9087.24.08376-X
Brindisino F, Girardi G, Crestani M, et al. Rehabilitation in subjects with frozen shoulder: a survey of current (2023) clinical practice of Italian physiotherapists. BMC Musculoskelet Disord 2024;25:573. DOI: https://doi.org/10.1186/s12891-024-07682-w
Privitera E, D'Abrosca F, Gaudiello G, et al. Physiotherapist involvement in the pandemic era: a Lombardy region survey. Monaldi Arch Chest Dis 2021;91:1762. DOI: https://doi.org/10.4081/monaldi.2021.1762
Cordani C, Perillo S, Corbetta D, et al. Developing physiotherapy in primary health care: a first snapshot from the Italian Metropolitan City of Milan. Healthcare 2024;12:1628. DOI: https://doi.org/10.3390/healthcare12161628
Paci M, Cordani C. On "physical therapists in primary care in the United States: an overview of current practice models and implementation strategies" O'Bright K, Peterson S. Phys Ther 2024;104:pzae123. 10.1093/ptj/pzae123. Phys Ther 2025;105:pzaf039. DOI: https://doi.org/10.1093/ptj/pzaf039
Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the Heart Failure Society of America. Circulation 2017;136:e137-61. DOI: https://doi.org/10.1161/CIR.0000000000000509
Koolen EH, van den Borst B, de Man M, et al. The clinical effectiveness of the COPDnet integrated care model. Respir Med 2020;172:106152. DOI: https://doi.org/10.1016/j.rmed.2020.106152
Haynes JM, Kaminsky DA, Ruppel GL. The Role of Pulmonary Function Testing in the Diagnosis and Management of COPD. Respir Care 2023;68:889-913. DOI: https://doi.org/10.4187/respcare.10757
Morrow B, Zampoli M, van Aswegen H, Argent A. Mechanical insufflation-exsufflation for people with neuromuscular disorders. Cochrane Database Syst Rev 2013;12:CD010044. DOI: https://doi.org/10.1002/14651858.CD010044.pub2
Holland AE, Malaguti C, Hoffman M, et al. Home-based or remote exercise testing in chronic respiratory disease, during the COVID-19 pandemic and beyond: a rapid review. Chron Respir Dis 2020;17:1479973120952418. DOI: https://doi.org/10.1177/1479973120952418
Rochester CL, Alison JA, Carlin B, et al. Pulmonary rehabilitation for adults with chronic respiratory disease: an official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med 2023;208:e7-26.
Al Chikhanie Y, Veale D, Schoeffler M, et al. Effectiveness of pulmonary rehabilitation in COVID-19 respiratory failure patients post-ICU. Respir Physiol Neurobiol 2021;287:103639. DOI: https://doi.org/10.1016/j.resp.2021.103639
Cai Y, Ren X, Wang J, et al. Effects of breathing exercises in patients with chronic obstructive pulmonary disease: a network meta-analysis. Arch Phys Med Rehabil 2024;105:558-70. DOI: https://doi.org/10.1016/j.apmr.2023.04.014
Hay MC, Weisner TS, Subramanian S, et al. Harnessing experience: exploring the gap between evidence-based medicine and clinical practice. J Eval Clin Pract 2008;14:707-13. DOI: https://doi.org/10.1111/j.1365-2753.2008.01009.x
Belli S, Prince I, Savio G, et al. Airway clearance techniques: the right choice for the right patient. Front Med 2021;8:544826. DOI: https://doi.org/10.3389/fmed.2021.544826
Davies L, Hinman RS, Russell T, et al. An international core capability framework for physiotherapists to deliver quality care via videoconferencing: a Delphi study. J Physiother 2021;67:291-7. DOI: https://doi.org/10.1016/j.jphys.2021.09.001
Rabanifar N, Hoseini MA, Abdi K. Exploring barriers to implementing telerehabilitation from experiences of managers, policymakers, and providers of rehabilitation services in iran: a qualitative study. Med J Islam Repub Iran 2022;36:157. DOI: https://doi.org/10.47176/mjiri.36.157
How to Cite
“Home-Based and Telehealth Cardio-Respiratory Physiotherapy in Northern Italy: A Cross-Sectional Survey”. 2025. Monaldi Archives for Chest Disease, December. https://doi.org/10.4081/monaldi.2025.3652.
Copyright (c) 2025 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.